@layout("/common/_form.html",{js:["/assets/modular/system/bankTest/bankTest_add.js"],css:["/assets/expand/module/formSelects/formSelects-v4.css"]}){

<form class="layui-form" id="bankTestForm" lay-filter="bankTestForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="id" type="hidden"/>

                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">订单编号<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="ddbh" name="ddbh" placeholder="请输入订单编号" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">交易日期<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="jyrq" name="jyrq" placeholder="请输入交易日期" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">记账日期<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="jzrq" name="jzrq" placeholder="请输入记账日期" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">交易金额<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="jyje" name="jyje" placeholder="请输入交易金额" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">支付卡号<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="zfkh" name="zfkh" placeholder="请输入支付卡号" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">场景标识<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="cjbs" name="cjbs" placeholder="请输入场景标识" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">商户柜台代码<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="shgtdm" name="shgtdm" placeholder="请输入商户柜台代码" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" ew-event="closeDialog">&emsp;取消&emsp;</button>
    </div>

</form>

@}